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Tailor-made treatment

Summer 2015

Receiving a diagnosis of breast cancer can be terrifying, but when you’ve also watched your mother wage the same battle – it can hit home on an even deeper level. That was certainly so for Margaret Greene who, at 68 years old, discovered a lump in her breast.

“It turned my whole world upside down,” she says of hearing her family doctor deliver the diagnosis of a very aggressive form of cancer present in both breasts. “I thought, how could this happen to me?”

The course of treatment for Margaret would be lengthy and complicated by other health conditions. As a diabetic, she could not undergo chemotherapy and, after a double mastectomy, lymph node surgery and radiation, the medication prescribed to her became a crucial part of her journey back to health. An inhibitor drug called tamoxifen, designed to prevent the resurgence of cancer, was added to the many medications prescribed to keep her recovery on track.

But Margaret’s body did not react well to the medication mix. She developed arthritis and spent her days feeling nauseated.“I just couldn’t tolerate any of them,” she says of the drugs.

When it became clear that her wellbeing was suffering under the very treatment designed to save her life, she was referred to LHSC’s Dr. Richard Kim and the Personalized Medicine Clinic.

Personalized medicine is a new way of practicing medicine where a patient’s medication history, diet, environmental factors and their genetic makeup are all examined with the goal of tailoring the best medical treatments for each unique individual.

At the LHSC Personalized Medicine Clinic, Dr. Kim analyzed Margaret’s blood to learn how her body was metabolizing (using) the tamoxifen – a key measure of whether or not the drug was effective.

“What we found was that another medication that she was taking was having a significant interaction with the tamoxifen – dramatically lowering its efficiency. Because the drug wasn’t working efficiently, this meant that she was also potentially exposed to the risk of breast cancer recurrence,” says Dr. Kim.

“Learning about how the body is using tamoxifen is very important. As patients typically need to take it for five to 10 years, you want to know you’re getting the maximum benefit. Our approach through the Personalized Medical Clinic enables very specific treatment adjustments that do just that for each individual we see.”

After discovering the interaction, and with her physician’s help, Margaret was weaned off of the drug that was reducing the tamoxifen’s effectiveness and the level of the active tamoxifen in her system increased four-fold, so that its efficacy reached a level that fell within the normal range.

“I had never heard of personalized medicine before,” says Margaret. “But Dr. Kim was very interesting to talk to. He gave me a lot of positive thoughts and the staff that he has working there are just wonderful.”

Margaret’s plan is so detailed, she even knows the right time of day to take the medication.

“I’m able to tolerate the tamoxifen,” says Margaret, adding that she no longer has nausea. Now, seven years after her initial breast cancer diagnosis, Margaret is, and remains, cancer free. She vividly recalls receiving the good news. “It was just wonderful. I was delighted,” she says with smile. “The diagnosis and drug side-effects had turned my world upside down, but hearing that I was cancer-free turned it back up again.”

For others who may find themselves battling illness, Margaret offers words of encouragement.

“Cherish every moment in every stage of your journey. Positive thoughts are a must. Each day will feel brighter if you accept what’s going on.”

Although she is now cancer-free, Margaret must continue taking tamoxifen to ensure that she stays that way.

Thankfully, her tailor-made plan ensures that she continues to receive the right dose, of the right medication, at the right time.

Learn about the research that Dr.Kim and his team conduct, and what compels them to keep moving forward.

About the Personalized Medicine Clinic at LHSC

In 2006, Dr. Kim and several of his team members were recruited to LHSC from Vanderbilt University’s School of Medicine in Nashville, Tennessee, with a goal of translating genomics research into better patient care. In 2008, Dr. Kim developed Canada’s first personalized medicine clinic at LHSC, starting with patients on a blood-thinning drug called warfarin, and expanding in 2010 to also treat breast cancer patients who are put on the drug tamoxifen.

Appointments to the clinic are made through physician referrals.

Currently, Dr. Kim and his personalized medicine team provide both inpatient as well as ambulatory clinic consultation service for a wide variety of drugs used to treat heart disease, inflammatory bowel disease and cancer.

Dr. Kim serves as Chair of the Division of Clinical Pharmacology in the Department of Medicine at Western University, and also holds the Wolfe Medical Research Chair in Pharmacogenomics.

Donors support the future of personalized medicine

Thanks in part to visionary donors, personalized medicine – physicians treating patients based on their unique DNA – is becoming a reality. A major focus of the Personalized Medicine Program at LHSC is preventing adverse drug reactions (ADRs). In addition to the serious health threat they pose, ADRs have a major economic impact; a conservative estimate of the yearly cost to Canadians is $1 billion.

Using pharmacogenomics, renowned clinical pharmacologist Dr. Richard Kim is addressing this challenge, understanding that the safest and most effective drug treatments work with, not against, a patient’s unique genetic code.

Donors to London Health Sciences Foundation who support the creation of the only hospital-wide personalized medicine program in Canada are helping to provide families with the safest possible care. The goal of the Personalized Medicine Program is to create a future where patient outcomes are improved – not just in London but around the world as Dr. Kim shares his innovative research.